Sr Case Manager - Long Term Care, 35 hrs/wk, Monday - Friday

Job Title:  Senior Case Manager - LTC                                                          
Job Location:  Lincoln
Immediate Supervisor: Administrator Long Term Care Services
Status:  Non-Exempt                                
 
 
JOB OVERVIEW
 
Responsible for the collaborative team process which assesses, plans, implements, coordinates, monitors and evaluates the options and services to meet the patientâ??s health needs, using communication and available resources to promote quality, cost effective outcomes.  These duties include the development of the patientâ??s overall plan of care including the identification, periodic review and revision, and communication of an individualized interdisciplinary plan of care.  The case manager is accountable for meeting quality patient outcomes and service delivery based on (1) appropriate length of stay, (2) effective utilization of resources including program utilization, (3) continuity through a continuum of care, and (4) established standards.  Serves as a liaison between patient, family, payor, team and physician; facilitation of education and training for patients, families and caregivers; for overall coordination of the patientâ??s program.  Additional responsibilities include the supervision of case management and social work staff for assigned program(s).  

ESSENTIAL FUNCTIONS

• Analyze patients past and current status, assess impairments, disabilities and handicaps in order to plan, coordinate, implement and monitor an effective and efficient plan of care.
• Analyze and monitor patientâ??s need for specialized tests, equipment, transportation, etc., in order to coordinate the provision of and payment for such services.
• Monitor the patientâ??s current status as well as information in the medical record to evaluate and ensure the appropriate provision of care.
• Compile, synthesize and enter FIM data into E-rehab in order to facilitate accurate reimbursement and/or program evaluation reporting and analysis.
• Analyze, assess and monitor patientâ??s financial information through the use of the Patient Based Income Statements (PBIS) and/or other sources in order to maximize appropriate utilization of resources.
• Compile, coordinate and analyze patientâ??s program information in accordance with the requirements of third party payors in order to maximize appropriate utilization of patientâ??s financial benefits.
• Coordinate and compile information regarding patientâ??s status and outcomes, unplanned discharges and patient followup to assess customer satisfaction, facilitate problem resolution, and contribute to evaluation of the program.
• Compile and analyze information to monitor patientâ??s response to the current treatment plan, assess available, clinically and financially appropriate alternatives in order to plan and implement appropriate placement in the continuum of care.
• Compile and analyze patient, program and facility clinical and financial data in order to evaluate and improve patient outcomes, and maintain program viability.
• Coordinate and compile patient information in order to ensure that discharge arrangements are completed and facilitate the implementation of discharge recommendations.
• Integrate department care coordination and rehabilitation program protocols to facilitate interdisciplinary team functioning.
• Assist in the organization and monitoring of case management service compliance with federal, state and accrediting body standards to ensure quality service delivery, rehabilitation program outcomes and CARF accreditation.
• Negotiate, instruct and speak with third party payor representatives in order to develop contractual arrangements for services when necessary.
• Negotiate, instruct and speak with external case managers regarding patientâ??s clinical program in order to coordinate and evaluate the program, maximize patient outcomes, and appropriate utilization of resources.
• Negotiate, instruct and speak with interdisciplinary team and other stakeholders in order to ensure that discharge arrangements are complete and facilitate the implementation of discharge recommendations.
• Negotiate, instruct and speak with team members, patients and families, and other stakeholders to coordinate followup in order to ensure customer satisfaction.
• Negotiate and speak with supervisor and other appropriate staff regarding difficult case situations and/or interdisciplinary team difficulties in order to assess, monitor and evaluate quality service delivery.
• Instruct and speak with new department employees, team members, students and colleagues in order to recruit and retain a quality work force, and enhance the profession.
• Supervises and evaluates case managers and social workers for assigned program(s) through completion of performance reviews and informal discussions/consultations to ensure quality care and compliance with standards.
  
  QUALIFICATIONS
  
• Must be a Registered Nurse or a Bachelors Degree professional in an allied health area (social work, occupational therapy, physical therapy, speech pathology, rehabilitation counseling, etc.).
• Must have a minimum of 3 years clinical experience, one of which must be in physical rehabilitation, with competence in broad areas of case management and team facilitation.
• General knowledge of Medicare and Medicaid programs and basic knowledge of indemnity and managed care insurance required.
• Knowledge of general rehabilitation principles, community resources and group dynamics required.
• Must possess and maintain current licensure/certification in area of clinical practice.